RESUMO
Fractures of the mandibular condylar process are common and account for up to 40% of all mandibular fractures. Penetration of the condylar head into the middle cranial fossa is, however, rare. We have found reports of only 43 cases since 1834. The diagnosis of intracranial condylar dislocation is difficult, there are usually no particular symptoms or neurological signs. As a result, detailed radiological studies are necessary. In the absence of clear radiographic images of the condylar structures, computed tomography (CT) is essential to locate the fragments and to investigate and monitor intracranial lesions. This paper describes the diagnostic and surgical procedures used in two cases of condylar dislocation and discusses them with reference to previous cases. The use of a titanium screw, which was positioned intracranially in the first case, has not, to our knowledge, been described previously.
Assuntos
Luxações Articulares/diagnóstico por imagem , Côndilo Mandibular/lesões , Fraturas Mandibulares/diagnóstico por imagem , Placas Ósseas , Transplante Ósseo , Criança , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Base do Crânio/diagnóstico por imagem , Contenções , Osso Temporal/lesões , Articulação Temporomandibular/lesões , Disco da Articulação Temporomandibular/lesões , Tomografia Computadorizada por Raios XRESUMO
The benefit of decompressive craniectomy for the treatment of uncontrolled post-traumatic intracranial hypertension seems to be encouraging if medical management fails. We present our experience in 22 cases of cerebral edema due to head trauma. The edema alone was rarely the direct consequence of head trauma. Frequently it was associated with an acute subdural or extradural hematoma and contusion (with or without mass effect). First of all we treated the mass effect of the hematoma and contusion when the diameter was more than 3 cm. Intracranial pressure was monitored in the majority of patients. Bone decompression was performed in the operating theatre depending on the values of intracranial pressure. In our series 41% of patients had a good recovery, 18% a severe disability, 23% a vegetative state and 18% died. The findings showed that the bony decompression must be performed early before the situation becomes irreversible. We suggest that if intracranial pressure values remain greater than 30 mmHg with cerebral perfusion pressure below 70 mmHg, despite vigorous anti-edema therapy, decompressive craniectomy should be considered.
Assuntos
Edema Encefálico/cirurgia , Lesões Encefálicas/cirurgia , Craniotomia , Descompressão Cirúrgica , Hipertensão Intracraniana/cirurgia , Adolescente , Adulto , Dano Encefálico Crônico/etiologia , Dano Encefálico Crônico/mortalidade , Edema Encefálico/mortalidade , Lesões Encefálicas/mortalidade , Criança , Feminino , Hematoma Subdural/mortalidade , Hematoma Subdural/cirurgia , Humanos , Hipertensão Intracraniana/mortalidade , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Taxa de SobrevidaRESUMO
We present the clinical and neuroradiological features of a ruptured aneurysm at the beginning of the left PICA suffering from subarachnoid hemorrhage (SAH). The young patient refused surgery, endovascular treatment and also follow-up. After 4 and 5 years she repeated the left vertebral angiography that showed a spontaneous thrombosis of the aneurysm. After 8 years MR angiogram images confirmed the total obliteration of the aneurysm.
Assuntos
Cerebelo/irrigação sanguínea , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/terapia , Adulto , Angiografia Cerebral , Feminino , Humanos , Aneurisma Intracraniano/complicações , Hemorragia Subaracnóidea/etiologia , VasoconstriçãoRESUMO
A patient suffering for an ischemic "locked-in" syndrome following a subarachnoid hemorrhage, was evaluated with brain stem acoustic evoked potentials (BAEPs), short latency somatosensory evoked potentials (SEPs) and motor evoked potentials (MEPs). Neuroradiological findings failed to reveal any lesion in the brain stem, while a transcranial Doppler showed increased flow velocity upon the basilar artery, suggesting vascular spasm. BAEPs were normal and SEPs showed to be slightly impaired while MEPs upon magnetic cortical stimulation were heavily deranged. Neurophysiological investigations appeared remarkable for the early diagnosis of the disease, when neuro-radiological findings were still negative.
Assuntos
Tronco Encefálico/fisiopatologia , Potenciais Evocados , Atividade Motora/fisiologia , Quadriplegia/fisiopatologia , Adulto , Aneurisma Roto/complicações , Artéria Basilar , Potenciais Evocados Auditivos do Tronco Encefálico , Potenciais Somatossensoriais Evocados , Feminino , Humanos , Aneurisma Intracraniano/complicações , Ataque Isquêmico Transitório/complicações , Ataque Isquêmico Transitório/fisiopatologia , Quadriplegia/diagnóstico , Quadriplegia/diagnóstico por imagem , Quadriplegia/etiologia , Ruptura Espontânea , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/fisiopatologia , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler TranscranianaRESUMO
During cerebral aneurysms surgery, brain tissue may suffer for global or local ischemia due to deliberate hypotension and surgical manoeuvres. Somatosensory evoked potentials (SEPs) can detect functional derangements consequent to hypoxia, before a permanent brain damage is produced. Forty two patients, undergoing cerebral aneurysms surgery for treatment of SAH, were evaluated intraoperatively with SEP recordings. It has been stressed that no permanent neurological damage is to be expected if the absolute value of Central Conduction Time (CCT) does not exceed 9.5 ms for 10 min at least and the cortical waves are visible throughout the whole procedure. SEP changes are strictly related with MAP decrease and surgical handlings.
Assuntos
Potenciais Somatossensoriais Evocados , Aneurisma Intracraniano/cirurgia , Monitorização Intraoperatória/métodos , Adulto , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/etiologia , Circulação Cerebrovascular , Feminino , Humanos , Hipotensão Controlada/efeitos adversos , Masculino , Pessoa de Meia-IdadeRESUMO
The transcranial doppler (T.C.D.) is a non-invasive technique useful for the evaluation of vasospasm and intracranial hypertension in patients with subarachnoid hemorrhage (S.A.H.). Eighteen patients with recent S.A.H. were studied by means of T.C.D. device: in 14 patients the source of bleeding was a ruptured aneurysm of the circle of Willis, while the remaining 4 presented a negative four-vessels angiography. All the patients were studied 5 and 10 days after the bleeding. Our data showed that the ultrasonographic demonstration of vasospasm and/or I.C.H. is clearly related to the clinical status of the patients. No significant T.C.D. difference was noticed between the "sine materia" S.A.H. patients and the ones with ruptured aneurysm.